What are the considerations for a patient with thrombocytopenia undergoing Transurethral Resection of the Prostate (TURP)?

From the Guidelines

Patients with thrombocytopenia undergoing Transurethral Resection of the Prostate (TURP) should be carefully evaluated due to increased risk of bleeding complications.

Key Considerations

• Bleeding risk: The use of oral anticoagulants or antiplatelet medications, which may be related to thrombocytopenia management, can lead to longer catheterisation and hospitalisation times, and higher blood transfusion and re-hospitalisation rates 1.
• Surgical approach: Bipolar TURP (B-TURP) has a more favourable perioperative safety profile than Monopolar TURP (M-TURP), which may be beneficial for patients with thrombocytopenia 1.
• Preoperative management: Careful management of thrombocytopenia and associated medications is crucial to minimize bleeding risks and optimize outcomes.

Perioperative Risks

• Mortality and morbidity: The perioperative mortality and morbidity of M-TURP are significant (0.1% and 11.1%, respectively), and patients with thrombocytopenia may be at higher risk 1.
• Blood transfusion: Patients with thrombocytopenia may require blood transfusions, which can increase the risk of complications and longer hospital stays 1.

From the Research

Considerations for Patients with Thrombocytopenia Undergoing TURP

• Patients with thrombocytopenia undergoing Transurethral Resection of the Prostate (TURP) require careful consideration of their bleeding risk and management of antiplatelet and anticoagulant medications 2, 3, 4.
• The management of antiplatelet and anticoagulant medications should be based on the patient's individual risk of thromboembolic complications and the American College of Chest Physicians thromboembolic risk stratification 2, 4.
• Patients with a low-risk profile may have their antiplatelet medications discontinued, while those with a medium or high-risk profile may continue taking their medications or have them bridged with other medications 2, 4.
• The use of hemostatic energy sources such as laser and bipolar technologies may help reduce the risk of bleeding during TURP 3.
• Patients undergoing TURP are at risk of developing TURP syndrome and non-surgical post-TURP bleeding, which may be due to the presence of fibrinolytic agents in the urine, including urokinase and tissue plasminogen activator (tPA) 5.
• Monitoring of patients' coagulation profiles and electrolytes after TURP is recommended due to the risk of developing severe acute hyponatremia, TURP syndrome, fibrinolytic changes, and non-surgical bleeding 5.

Bleeding Risk and Management

• The bleeding risk in TURP procedures is generally considered low, and the use of patient blood management strategies may not be beneficial in these cases 6.
• However, patients with preoperative anemia may be at increased risk of postoperative morbidity and mortality, and preoperative initiation of treatment for anemia may be considered 6.
• The use of antifibrinolytic agents such as Tranexamic acid may be effective in reducing the risk of post-TURP bleeding by antagonizing the fibrinolytic activity of urine urokinase and tPA 5.

Perioperative Management

• Perioperative management of patients undergoing TURP should include careful consideration of their bleeding risk and management of antiplatelet and anticoagulant medications 2, 3, 4.
• Patients should be monitored closely for signs of bleeding or thromboembolic complications, and their coagulation profiles and electrolytes should be monitored after TURP 5.
• The use of hemostatic energy sources and antifibrinolytic agents may help reduce the risk of bleeding during and after TURP 3, 5.